Dawood Kamran, Rana Faraz S, Khan Zahid, Ranjit Arun
Cardiology, Mid and South Essex National Health Service (NHS) Foundation Trust, Southend-on-Sea, GBR.
Cardiology, Aintree University Hospital, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, GBR.
Cureus. 2025 Jul 10;17(7):e87653. doi: 10.7759/cureus.87653. eCollection 2025 Jul.
Aortic root abscess is a rare and serious complication of infective endocarditis (IE). The presentation can be vague, and a high degree of suspicion is usually required. We present the case of a 78-year-old woman with a previous history of aortic valve replacement (AVR) surgery eight months ago who presented to the Accident and Emergency (A&E) department after falling at home. After initial scrutiny, her electrocardiogram (ECG) showed complete heart block, for which she received a dual-chamber permanent pacemaker. At that time, due to suspected chest infection, her laboratory tests showed slightly elevated C-reactive protein levels, but blood cultures and chest radiography did not show any evidence of infection. She was administered oral antibiotics for a chest infection and underwent successful pacemaker implantation. After approximately a week, she presented again with generalized weakness and collapse without loss of consciousness. Repeated blood tests showed elevated inflammatory markers, and blood cultures were positive for ; therefore, intravenous antibiotics were administered Transesophageal echocardiography (TEE) revealed an aortic root abscess, and ECG revealed a normal sinus rhythm. She also underwent pacemaker interrogation, which revealed normal pacemaker function. She also had a recent overseas travel history and required intensive care admission for a chest infection approximately two months ago, and she had been feeling generally unwell since then. The patient underwent tissue AVR (TAVR) for degenerative calcific aortic stenosis (AS) without periprocedural complications and recovered well after surgery. She was discussed in a multidisciplinary team meeting and was referred for early redo AVR. Unfortunately, the patient died during admission due to sepsis prior to undergoing redo valve surgery.
主动脉根部脓肿是感染性心内膜炎（IE）一种罕见且严重的并发症。其表现可能不明确，通常需要高度怀疑。我们报告一例78岁女性病例，她八个月前有主动脉瓣置换（AVR）手术史，在家中摔倒后就诊于急症室（A&E）。初步检查后，她的心电图（ECG）显示完全性心脏传导阻滞，为此她接受了双腔永久性起搏器植入。当时，由于怀疑有胸部感染，她的实验室检查显示C反应蛋白水平略有升高，但血培养和胸部X线检查未显示任何感染迹象。她因胸部感染接受了口服抗生素治疗，并成功植入了起搏器。大约一周后，她再次出现全身无力和虚脱，但未失去意识。重复血液检查显示炎症标志物升高，血培养 呈阳性；因此，给予了静脉抗生素治疗。经食管超声心动图（TEE）显示主动脉根部脓肿，心电图显示窦性心律正常。她还接受了起搏器程控，结果显示起搏器功能正常。她近期还有海外旅行史，大约两个月前因胸部感染需要入住重症监护病房，从那时起她就一直感觉身体不适。该患者因退行性钙化性主动脉瓣狭窄（AS）接受了经导管主动脉瓣置换术（TAVR），围手术期无并发症，术后恢复良好。她在多学科团队会议上进行了讨论，并被转诊接受早期再次AVR。不幸的是，患者在入院期间因败血症在接受再次瓣膜手术前死亡。
